AT RISK APPROACH
-IMPLEMENTATION IN
DIFFERENT STRATA IN
THE COMMUNITY
PRESENTED BY:- DR.NAVIN KUMAR
Why this presentation?
India with a population of more than 1.22
billion scattered in 28 states and 7 union
territories pr...
This presentation aims at:-
1. Illustrating the definition of RISK;
2. Defining the population at risk;
3. Imparting knowl...
WHAT IS RISK?
―Something with the potential to cause harm‖
WHAT IS RISK?
RISK:- The probability of harmful
consequences, or expected losses (deaths, injuries,
property, livelihood,...
R = H x V
RISK= Cross product of Hazard and Vulnerability.
HAZARD = The probability of an adverse outcome.
VULNERABILITY= ...
NOW
WHAT TO DO
NEXT?
ASSESSMENT OF RISK
RISK ASSESSMENT:- It is a
process of estimating the magnitude
of the risk and deciding if the risk is
tolerable or accepta...
RISK ASSESSMENT
It is a systematic procedure for describing and
quantifying the risk associated with hazardous
substance, ...
RISK ASSESSMENT
What Risk Analysis Can Do?
Helps in:-
# Forecasting any unwanted situation.
# Estimating damage potential of such situatio...
GUIDELINES FOR DEFINING
GROUPS ―AT-RISK‖
BIOLOGICAL SITUATIONS:-
AGE GROUP—INFANTS with low birth
weight, ELDERLY etc.
SEX--FEMALES in reproductive age group.
PHYS...
PHYSIOLOGICAL SITUATION
-RURAL, URBAN, SLUMS.
-LIVING CONDITIONS, OVERCROEDING
-ENVIRONMENT: Water supply, Industries,
Pol...
SOCIOCULTURAL AND
CULTURAL SITUATION.
-Social class.
-Ethnic and cultural group.
-Family disruption, Education, Housing...
AT RISK APPROACH
AT “RISK APPROACH” DEALS WITH
THOSE INDIVIDUALS AND GROUPS
WHO ARE AT PERTICULAR HIGH
RISK AND EMERGENT ...
THE ULTIMATE GOAL
AT RISK IN FAMILIES
PREGNANT
WOMEN
LACTATING
MOTHERS
CHILDREN
< 2YEARS
SEVERELY
MALNURISHED
CHILDREN <5
YEARS
DISABLED
FAM...
RAGHU PANDA
89 years old
Lives alone
Has no land, family lives out of state
History of heart disease
KAMLA
7 years old
Par...
AN EFFECTIVE ―AT RISK APPROACH‖
INVOLVES FIVE MAIN STAGES:-
A: Recruitment and Referral –
B: Comprehensive health assessme...
23
A Simple Framework
Evaluate
& Take
Action
Establish
Objectives
Identify
Risks &
Controls
Assess
Risks &
Controls
Monito...
Policies related to Health Sector
For population at Risk
National Health Policy
Nutrition Policy
Women Policy
Training...
Policy Interventions.
From Quantity to
Quality
Upgradation of Skills
Static Centres for
Improved access to
services
Upgra...
MODEL OF HEALTH CARE
SYSTEM
HEALTH
STATUS
0R
HEALTH
PROBLEMS
RESOURCES
CURATIVE
PREVENTIVE
PROMOTIVE
PUBLIC
PRIVATE
VOLUNT...
GOVT HAVE TO IDENTIFY THESE FAMILY AND
PROVIDE APPROPRIATE HELING HANDS TO THESE
FAMILY.
# JANANI SURAKSHA YOJANA.
# MAMTA...
Population Program
Promotional Measures
 providing fertility regulating information/services.
 furnishing family life/se...
REPRODUCTIVE AND
CHILD HEALTH (RCH)
– Conceptual frame work:
Client
centered
approach
Family welfare/Plan
CHILD
SURVIVAL &...
RISK APPROACH IN
ANTENATAL CARE
AIM :- To identify the HIGH RISK
ANTENETAL CASES to provide specialized
care and appropri...
ASHA WORKERS AT THEIR DUTIES.
NEW BORNS & INFANTS
LOW BIRTH WEIGHT
PRE TERM BABIES
NEONATAL DEATHS
EARLY WEANING
RTI
UNDER FIVE AGE GROUP CHILDREN
 MALNUTRITION
 FOOD POISONING
 ACUTE DIARRHOEAL DISEASES
 PROTEIN-ENERGY MALNUTRITION
 ...
Mid day meal programme
PRINCIPLES:
 1. Meal a supplement – not a
substitute.
 2. 1/3rd of total calorie requirement.
 ½...
YOUNG & ADOLESCENCE AGE
GROUP
# GUTHKA CHEWING
# TOBACCO CHEWING
# ALCOHOL
# SMOKING
# UNSAFE SEX
# UNHEALTHY LIFE STYLE
OUTCOME
ORAL CANCER
LUNG CANCER
STD / HIV-AIDS / HPV
LIVER DISEASES
UN-EMPLOYMENT
MENTAL DISORDERS
RASH DRIVING - R...
ROAD TRAFIC ACCIDENTS
RISK APPROACH
 BAN ON GUTHKA BY SEVERAL STATE GOVT.
 HEAVY SALES-TAX ON ALCOHOL, CIGARETTES AND ALL
TOBACCO PRODUCTS.
 ...
Geriatric population
 1980- 5.3%
 2000- 7.7%
 2025- 13.3% ( 1.2 billion )
 71% - Developing World
 70 million populat...
RISK OF GERIATRICS
 PRONE FOR INFECTIONS
 PRONE FOR INJURIES
 NEED SPECIAL ASSISTANCE
 PRONE FOR PSYCHOLOGICAL PROBLEM...
PREVENTION
Primordial prevention
 Pre geriatric care
Primary prevention
 Health education
 Exercise
Secondary preventio...
SUMMARY
HEALTH CARE AND POLICY SHOULD
BE GUIDED TOWARDS PREVENTION
BY A NUMERICAL ASSESSMENT OF
FUTURE NEED.
 IEC IS MUS...
HEALTH FOR ALL
At risk approach by DR NAVIN KUMAR
At risk approach by DR NAVIN KUMAR
At risk approach by DR NAVIN KUMAR
At risk approach by DR NAVIN KUMAR
At risk approach by DR NAVIN KUMAR
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At risk approach by DR NAVIN KUMAR

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  • Risk relates to the likelihood of the harm or undesired event occurring, and the consequences of its occurrence. It is the probability that the substance or agent will cause adverse effects under the conditions of use and or exposure, and the possible extent of harm.
  • Probability of an encounter between a specific HAZARD and an ELEMENT vulnerable to this is interpreted as a probability of occurrence of loss of life or damage to objects , buildings and the environment as the result of an extreme natural phenomenon with a specific strength of intensity.
  • ESTIMATION OF THE CHANCES OF AN ADVERSE OUTCOME WHEN ONE OR MORE RISK FACTORS ARE PRESENT, MEASUREMENT OF THEIR INTERACTION AS PREDICTORS, AND CALCULATIONS OF WHAT MIGHT HAPPEN TO THE HEALTH OF THE POPULATION IF THE RISK FACTORS WERE REMOVED MAKE POSSIBLE A NUMBER OF APPLICATIONS IN PREVENTIVE MEDICINE. THESE RISK, PREDICTIONS AND POSSIBLE EFFECTS ARE THEREFORE THE TOOLS OF THE RISK APPROACH.
  • It is critical to note that “at risk” is a concept that reflects a chance or a probability. It does not imply certainty.Risk factors raise the chance of poor outcomes, while protective factors raise the chance of good outcomes. It isvaluable for programs to understand the levels of risk and protective factors in their program clients, as well as oftheir potential clients. Such understanding can help in developing programs and also in obtaining funding for them.
  • Probability of an encounter between a specific HAZARD and an ELEMENT vulnerable to this is interpreted as a probability of occurrence of loss of life or damage to objects , buildings and the environment as the result of an extreme natural phenomenon with a specific strength of intensity.
  • RISK APPROACH IS THE ANTICIPATORY ACTIONS TAKEN TO REDUCE OR NULLIFY THE PROBABILITY OF THE OCCURRENCE OF A DISEASE, ILLNESS, ACCIDENT OR DEATH CAN BE REDUCED.
  • IN A FAMILY WE CAN SEE THAT THESE FAMILY MEMBERS ARE AT RISK AND PROPER CARE MUST BE TAKEN FOR THEIR HEALTHY OUTCOME.
  • A: Recruitment and Referral – can be achieved by Public awareness campaigning highlighting the danger signs and health screening system at various level of health care.B: Comprehensive health assessment- Assessment of individuals who are at risk. Identified subjects should have a detailed analysis including their personal history, family history, behaviour and complete physical examination.C: Setting appropriate target- The information gained from the health assessment should enable the Doctors or authority and Patient to agree on a realistic and appropriate goal. The management goal should be chosen on the basis of personal circumstances and associated risk factors. D : Implementing management strategies- Programmes and policies at different levels for different age groups according to their requirement and needs. E : Monitoring reward and evaluation- Regular review allow an excellent support to various management programmers, monitoring of medical conditions and early detection of problems associated with these protocols
  • Child survival and safe motherhood (1992) :- For children –1. Essential newborn care2. Immunization3. Appropriate management of Diarrhoea.4. Appropriate management of ARI.5. Vit A prophylaxis.For mothers-1. Immunization.2. Prevention and treatment of anemia.3. ANC4. Delivery by TBA.5. Promotion of institutional deliveries.6. Obstetric emergencies- Management.7. Birth spacing
  • HIGH RISK CASES:-ELDERLY PRIMI (&gt;30 YRS OF AGE) SHORT PRIMI(&lt;140 Cms IN HEIGHT)ANTEPARTUM HEAMORRHAGEANAEMIATWINSECLAMPSIAPRE-ECLAMPSIAPREVIOUS INSTRUMENTAL DELIVERYELDERLY GRAND MULTIPERAPRVIOUS STILL BIRTH, INTRA-UTERINE DEATH OR MANNUAL REMOVAL OF PLACENTAPROLONGED PREGNANCY (&gt;2WEEKS)DISEASES COMPLICATING PREGNANCY- HEART DISEASE, RENAL DISEASE, LIVER DISEASE TB… ETC….
  • At risk approach by DR NAVIN KUMAR

    1. 1. AT RISK APPROACH -IMPLEMENTATION IN DIFFERENT STRATA IN THE COMMUNITY PRESENTED BY:- DR.NAVIN KUMAR
    2. 2. Why this presentation? India with a population of more than 1.22 billion scattered in 28 states and 7 union territories provide a unique ground for studying population programs management . To provide any kind of service to its citizens, it needs a huge investment and a large manpower for its implementation.
    3. 3. This presentation aims at:- 1. Illustrating the definition of RISK; 2. Defining the population at risk; 3. Imparting knowledge on common elements of population policies; 4. Implementation in different strata in the community. OBJECTIVES
    4. 4. WHAT IS RISK? ―Something with the potential to cause harm‖
    5. 5. WHAT IS RISK? RISK:- The probability of harmful consequences, or expected losses (deaths, injuries, property, livelihood, economic activity disrupted or environment damaged) resulting from interactions between natural or human-induced hazards and vulnerabilities.  Risk is proportional to Hazard x Vulnerability / Level of Preparedness.
    6. 6. R = H x V RISK= Cross product of Hazard and Vulnerability. HAZARD = The probability of an adverse outcome. VULNERABILITY= The conditions determined by physical, social, economic and environmental factors or processes, which increase the susceptibility of a community to the impact of hazards.
    7. 7. NOW WHAT TO DO NEXT?
    8. 8. ASSESSMENT OF RISK
    9. 9. RISK ASSESSMENT:- It is a process of estimating the magnitude of the risk and deciding if the risk is tolerable or acceptable. A tolerable RISK may not always be acceptable.
    10. 10. RISK ASSESSMENT It is a systematic procedure for describing and quantifying the risk associated with hazardous substance, process, action or event. It involves: # Identification of hazard # Quantification of hazard # Quantification of probability of occurrence of hazard # Estimation of risk
    11. 11. RISK ASSESSMENT
    12. 12. What Risk Analysis Can Do? Helps in:- # Forecasting any unwanted situation. # Estimating damage potential of such situation. # Decision making to control such situation. # Evaluating effectiveness of control measures.
    13. 13. GUIDELINES FOR DEFINING GROUPS ―AT-RISK‖
    14. 14. BIOLOGICAL SITUATIONS:- AGE GROUP—INFANTS with low birth weight, ELDERLY etc. SEX--FEMALES in reproductive age group. PHYSIOLOGICAL STATE-- PREGNANCY, HTN, DM etc GENETIC FACTORS– Family history. OTHER HEALTH CONDITIONS-- Diseases, Physical functioning, Unhealthy behavior.
    15. 15. PHYSIOLOGICAL SITUATION -RURAL, URBAN, SLUMS. -LIVING CONDITIONS, OVERCROEDING -ENVIRONMENT: Water supply, Industries, Pollution etc.
    16. 16. SOCIOCULTURAL AND CULTURAL SITUATION. -Social class. -Ethnic and cultural group. -Family disruption, Education, Housing. -Customs, Habits and Behavior. -Access to Health services. -Lifestyle and Attitudes.
    17. 17. AT RISK APPROACH AT “RISK APPROACH” DEALS WITH THOSE INDIVIDUALS AND GROUPS WHO ARE AT PERTICULAR HIGH RISK AND EMERGENT NEED. 1PREVENTIVE 2PROMOTIVE 3MANAGEMENT
    18. 18. THE ULTIMATE GOAL
    19. 19. AT RISK IN FAMILIES PREGNANT WOMEN LACTATING MOTHERS CHILDREN < 2YEARS SEVERELY MALNURISHED CHILDREN <5 YEARS DISABLED FAMILY MEMBER
    20. 20. RAGHU PANDA 89 years old Lives alone Has no land, family lives out of state History of heart disease KAMLA 7 years old Parents are undocumented immigrants MALTI DEVI 35 years old, Pregnant Anaemic, weak, BPL, Lives 4 children & unemployed husband
    21. 21. AN EFFECTIVE ―AT RISK APPROACH‖ INVOLVES FIVE MAIN STAGES:- A: Recruitment and Referral – B: Comprehensive health assessment- C: Setting appropriate target- D : Implementing management strategies- E : Monitoring reward and evaluation-
    22. 22. 23 A Simple Framework Evaluate & Take Action Establish Objectives Identify Risks & Controls Assess Risks & Controls Monitor & Report Step 1 Step 2 Step 3 Step 4 Step 5 Communicate, learn, improve
    23. 23. Policies related to Health Sector For population at Risk National Health Policy Nutrition Policy Women Policy Training Policy Population Policy
    24. 24. Policy Interventions. From Quantity to Quality Upgradation of Skills Static Centres for Improved access to services Upgradation of facilities and Operations Research Integrated Services for Spacing Method Antenatal Care Deliveries Post-natal Care Immunization RTI Child Care
    25. 25. MODEL OF HEALTH CARE SYSTEM HEALTH STATUS 0R HEALTH PROBLEMS RESOURCES CURATIVE PREVENTIVE PROMOTIVE PUBLIC PRIVATE VOLUNTARY INDIGENOUS CHANGES IN HEALTH STATUS
    26. 26. GOVT HAVE TO IDENTIFY THESE FAMILY AND PROVIDE APPROPRIATE HELING HANDS TO THESE FAMILY. # JANANI SURAKSHA YOJANA. # MAMTA SCHEME. # RASHTRIYA SWASTH BIMA YOJANA. # BPL CARDS
    27. 27. Population Program Promotional Measures  providing fertility regulating information/services.  furnishing family life/sex education information.  improving the status of women.  improving health and nutritional status.  providing incentives and disincentives.  improving research and evaluation.  carrying out specific legal reforms to influence. internal and international migration.
    28. 28. REPRODUCTIVE AND CHILD HEALTH (RCH) – Conceptual frame work: Client centered approach Family welfare/Plan CHILD SURVIVAL & SAFE MOTHERHOOD (1992) RTIs &STDs
    29. 29. RISK APPROACH IN ANTENATAL CARE AIM :- To identify the HIGH RISK ANTENETAL CASES to provide specialized care and appropriate level of care to others.
    30. 30. ASHA WORKERS AT THEIR DUTIES.
    31. 31. NEW BORNS & INFANTS LOW BIRTH WEIGHT PRE TERM BABIES NEONATAL DEATHS EARLY WEANING RTI
    32. 32. UNDER FIVE AGE GROUP CHILDREN  MALNUTRITION  FOOD POISONING  ACUTE DIARRHOEAL DISEASES  PROTEIN-ENERGY MALNUTRITION  INFECTIONS AND PARASITOSIS  ACCIDENTS AND POISONING  BEHAVIOURAL PROBLEMS  RTI
    33. 33. Mid day meal programme PRINCIPLES:  1. Meal a supplement – not a substitute.  2. 1/3rd of total calorie requirement.  ½ of total protein requirement.  3. Ease of preparation.  4. Locally available. Ingredients.  5. Low cost.  6. Menu should be changed frequently.
    34. 34. YOUNG & ADOLESCENCE AGE GROUP # GUTHKA CHEWING # TOBACCO CHEWING # ALCOHOL # SMOKING # UNSAFE SEX # UNHEALTHY LIFE STYLE
    35. 35. OUTCOME ORAL CANCER LUNG CANCER STD / HIV-AIDS / HPV LIVER DISEASES UN-EMPLOYMENT MENTAL DISORDERS RASH DRIVING - RTA
    36. 36. ROAD TRAFIC ACCIDENTS
    37. 37. RISK APPROACH  BAN ON GUTHKA BY SEVERAL STATE GOVT.  HEAVY SALES-TAX ON ALCOHOL, CIGARETTES AND ALL TOBACCO PRODUCTS.  BAN ON ALCOHOL IN GUJRAT.  BAN ON SMOKING IN PUBLIC PLACES & PUBLIC TRANSPORTS.  PROPER LAW IMFORCEMENT TO FOLLOW TRFFIC RULES.
    38. 38. Geriatric population  1980- 5.3%  2000- 7.7%  2025- 13.3% ( 1.2 billion )  71% - Developing World  70 million population in India-2001  177 million population -2025  40% below poverty line  73% illiterate
    39. 39. RISK OF GERIATRICS  PRONE FOR INFECTIONS  PRONE FOR INJURIES  NEED SPECIAL ASSISTANCE  PRONE FOR PSYCHOLOGICAL PROBLEMS  PRONE FOR DEGENERATIVE DISORDERS  INCREASED RISK FOR DISEASE  INCREASED RISK OF DISABILITY  INCRASED RISK OF DEATH
    40. 40. PREVENTION Primordial prevention  Pre geriatric care Primary prevention  Health education  Exercise Secondary prevention  Annual medical check-up  Early detection ( Universal approach, Selective approach)  Treatment Tertiary prevention  Counseling and Rehabilitation  Welfare activities (Sanjay Niradhar Yojana, Vridhashrama)  Chiropody services Improving quality of life  Cultural programme  Old age club  Meals-on wheel service  Economically support (Vridha pension Yojana )  Old age home
    41. 41. SUMMARY HEALTH CARE AND POLICY SHOULD BE GUIDED TOWARDS PREVENTION BY A NUMERICAL ASSESSMENT OF FUTURE NEED.  IEC IS MUST FOR IMPLEMENTATION LAW IMFORCEMENT SHOULD BE STRICT
    42. 42. HEALTH FOR ALL

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